Nothing More Worth It in The Life Of A Nurse

I admitted a woman to our ICU a few weeks ago with respiratory failure from a bad autoimmune disease. She was awaiting a lung transplant but had gotten too sick & required too much supplemental oxygen to stay either at home or on a general care floor. She came with her husband and family in tow and was cheerful and warm, right from the start.

I cared for her for all of my subsequent shifts, 12 hour days spent in and out of her room, meeting her various family members and chatting with her about her life and hobbies before the hospital. I talked with her a bit about Claire, about where I grew up, about my husband. I heard about her love of tennis, about her favorite new hot yoga studio, about the small business that she had owned for the last 26 years downtown that she couldn't wait to get back to. She was endlessly thankful, always going out of her way to appreciate my time and attention and her entire family was respectful and courteous - an unfortunately rare thing and thus that much more endearing.

I last had her on Friday, handing her care off that night to one of my favorite night nurses. This patient had deteriorated over the course of the day, having heard from the main lung doctor that her time was limited and that if she didn't get a transplant by the end of the weekend, she likely would not survive the next week. His words seem to deflate a part of her that had been hopeful and optimistic all of the rest of our time together. The reality that her shred of hope in a transplant was likely going to be dashed seemed to dim a flame that had been keeping her going. It was apparent something had shifted.

I had noticed her decline and had been assisting her more and more doing the cares she had previously done for herself. Where she had initially walked to the bathroom on her own, she was now needing a hand or two. Where she had previously been enjoying a wide variety of foods, she was now barely able to get a bite or two in between gasps for oxygen and long 'catch my breath' breaks. I knew her doctor was right but it made me ache to see her grasp the reality of his words.

I thought about her a lot over the weekend, fairly certain she would have passed away before I could return today. I thought of her fondly, thankful for the time we shared and the stories I learned from her and the kind woman she had always been despite a debilitating disease.

When I came into work this morning the charge nurse pulled me aside and asked if I could please take her as a patient today as she had requested me overnight to care for her if I were coming in. Of course I said yes and quickly went and got an update on how her weekend went.

Not well. She had continued to decline and hadn't let anyone bathe her, brush her teeth or change her clothes since we had done all of those things together on Friday. Her husband had been at bedside the whole time but had just gone home on Sunday night to get some sleep before coming back this morning.

My favorite night nurse who I had given this same patient to was the one now telling me how much had changed. How the patient's kidneys had failed, how her heart was giving out, how her gut had stopped receiving blood flow, how her hands and feet were turning purple from chronic oxygen deprivation. She was alive but her tissues were dying.

Before we could even finish the report, she put on her call light. One look at her delirious, lethargic and yet still so kind face told me everything I needed to know. She would not survive the day. She had doubled the amount of oxygen she needed, maxing out our capabilities, yet she was still gasping for air and whimpering "Please help me breathe. Please. Help me. Breathe." It was clear I needed to address her code status, get her some medication to help with that panicked feeling of 'air hunger' and get her husband in as quickly as possible.

I spoke with the respiratory therapist and the team of doctors. I called her husband and urged him to come in. I got the ball rolling because either we helped her die with peace and dignity or we simply let her suffer. She was dying either way and it is my job, my duty and my calling to ensure everyone who passes under my care does it with as much comfort as possible.

We started the pain medication drip, we sedated her just enough so she wasn't panicked and I got her an ice chip for her parched mouth. Her husband arrived shortly thereafter and he simply started to cry. "It wasn't supposed to go like this" he whisper-sobbed and I rubbed his back, agreeing and aching but aware my grief was a droplet in his sea of despair.

As the hour went on, she grew more and more sleepy from the medication but her room also filled up more and more with family. Loved ones, offering nothing more than a warm hand to rub her back or a sweet word to whisper in a hushed ear but they were there. I stayed at her bedside, trying to walk the fine line of being useful without being intrusive and I was thankful for an incredible team of nurses around me who picked up my other patient and allowed me the chance to be 100% present in this moment with this family.

The decision was made to remove her oxygen as she was breathing much more slowly and her body was beginning to officially shut down. Within a few minutes, her heart rate slowed to near nothing...and then stopped. My hand wrapped around one of hers, her other clenched tightly by her husband, she took her last breath and moved on. Her husband kissed her face, her cheeks, her hand and whispered "Be free, my love. Be free." and I wiped away tears from my own wet cheeks. We all hugged, me and her parents, her husband, her in laws, her siblings. We stood there, in that moment, with her body that already looked different, and we remembered her and celebrated her and simply respected the life she lead that was cut way, way too short.

I kept it together for the most part, helping them pack up her things and handing him the Happy Valentine's card he'd just given her three days ago and with more hugs, sent them on their way. My charge nurse, ever so aware and helpful, asked me if I wanted to step off the unit for a bit and that she'd watch my other patient. I walked right to the cafeteria, bought a huge chocolate muffin and a warm frosted scone and I snuck away to a deserted closet and I ate them and cried.

I cried because despite not really knowing her, I would miss her. I'd come to look forward to her "I'm so glad you are back - you're my favorite!" that she'd say when I walked in in the morning. I'd miss her fierce independence, her witty sense of humor, her raw honesty when she and I were alone, her passion for athletics and healthy living and organic cooking. I'd spent more time with her in the last few weeks collectively than I'd spent with my husband. She'd become a friend as well as a well respected patient and in those minutes by myself in a deserted closet, I mourned her in my own private way.

But as nurses must do, I pulled myself together and wiped away my tears and went back out there. I had another patient who needed me just as much, who I could still help in the present, who needed 100% of my focus and attention while I was in there. I texted my husband that I was having a rough day, he offered me love and encouragement and I went back to work. She isn't the first patient I've lost who touched me deeply and she certainly won't be the last. It's the patients like this, the ones who stick with us and change our lives and define why we put up with the really hard days that are my favorite. Sure, my heart felt raw and open today but it felt true and deep and real. She is the essence of why I know without a trace of doubt that this is my calling and despite the pain of losing patients like this, she epitomizes why I have to keep going back.

My job is hard and intense, incredibly rewarding and gratifying, the very best thing I do most days and the greatest honor. Tonight I will fall asleep remembering this wonderful lady and tomorrow I will wake up ready to meet a new patient who just might break my heart all over again...but there is absolutely nothing more worth it in the world.